The Impact of Early CT on Outcomes for Empyema Patients Admitted Through the Emergency Department

Empyema incidence is rising, with high mortality, and patients frequently requiring invasive procedural management. Early intervention is linked with reduced procedural invasiveness and rates of general complications. CT can aid diagnostic certainty and guide management approaches, but the value of CT timing on outcomes remains unclear.

Describe the association between CT timing and outcomes for patients diagnosed with Empyema who present through the emergency department.

A retrospective cohort study of adult empyema patients was performed using TriNetX data (2009 to 2025). Patients were stratified based on timing of CT thorax: patients who received CT the same day as an emergency room (ER) admission (early) versus patients who received CT 1 to 3 days after ER admission (late). Outcomes were assessed at 30 days and included mortality, surgical intervention of any of the lungs, pleura, trachea, or bronchi, ER readmission, and requirement of ventilator support. Kaplan-Meier survival, logistic regression, and frequency-based outcome analyses were performed.

After matching for demographics, both cohorts included 2250 patients. The mean age was 44 years, and patients were 66% White and 60% male. There were no significant differences in vital signs or leukocyte count between cohorts. Early CT patients experienced significantly lower mortality (98.2% vs. 96.3%; P =0.0002; HR=0.488), a lower risk of invasive surgery (26.7% vs. 40.4%; P <0.0001; RR=0.661), and reduced risk for requiring ventilator support (8.9% vs. 11.7%; P =0.0017; HR=0.748). Early CT was associated with increased all-cause ER readmission (23.47% vs. 17.07%, P <0.0001; RR=1.375).

Pyothorax management is of ongoing interest given associated morbidity/mortality, high treatment costs, and frequency of invasive procedures. Early CT is associated with decreased mortality, decreased invasive surgical requirement, decreased ventilator dependence, and increased all-cause 30-day ER readmission.